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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283009917
Report Date: 09/24/2021
Date Signed: 09/24/2021 01:48:42 PM

Document Has Been Signed on 09/24/2021 01:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:NARVAEZ, GABRIELA FCCHFACILITY NUMBER:
283009917
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
09/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Gabriela Narvaez, LicenseeTIME COMPLETED:
02:10 PM
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A Required- 1 year inspection was made to the facility by Licensing Program Analyst (LPA) Kevin O'Connell. A review of staff records on 09/24/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are two adults living in the home.
During today’s inspection the home and grounds were toured.
The licensee and an assistant were supervising five children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are Monday - Friday; 07:30am - 05:00pm.
The living room, playroom are used for care. The kitchen, one bedroom (napping) and the bathroom (near the playroom) are accessible to children.
The off limits rooms were inaccessible with gates and door handle covers.
The garage is also off limits and has a door handle cover. The back yard is fully fenced and used for outdoor play. The home was clean and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. The Licensee has current pediatric CPR and First Aid certifications which expires 2/22.
Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. Poisons are thumb print/ combination locked in the garage.
The electric fireplace has a glass door and is not plugged in. There is a working smoke detector/ carbon monoxide combination detector and at least a 2A 10BC charged fire extinguisher. Firearms and ammunition are stored in separate safes in an "off limits" backyard shed. The Licensee states that there are no pools, spas, or water features and none were observed.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Kevin O'Connell
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: NARVAEZ, GABRIELA FCCH
FACILITY NUMBER: 283009917
VISIT DATE: 09/24/2021
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Two staff files were reviewed at 12:50pm for Mandated Reporter Certificates and immunizations and all were current. Five children's records were reviewed at 01:05pm; required emergency information cards were observed to be on file. There are no children receiving Incidental Medical Services at this time.
The following information regarding ADA was provided: US Department of Justice toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, www.ada.gov/childqanda.htm. This report was reviewed and discussed with the licensee.
All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

No Title 22 violations were cited during today's inspection.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Kevin O'Connell
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
LIC809 (FAS) - (06/04)
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